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Volume 5, Number 1—February 1999

Dispatch

Household Transmission of Streptococcus pneumoniae, Alberta, Canada

James D. Kellner†, A. Patrick Gibb†‡, Jenny Zhang§, and Harvey R. Rabin†
Author affiliations: Foothills Medical Centre and Alberta Children's Hospital, Calgary, Alberta, Canada;; †University of Calgary, Alberta, Canada;; ‡Calgary Laboratory Services, Alberta, Canada;; §Provincial Laboratory of Public Health, Calgary, Alberta, Canada

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Table

Clinical and laboratory features of three couples with Streptococcus pneumoniae pneumonia

Couple A Couple B Couple C
Feature Patient 1 Patient 2 Patient 1 Patient 2 Patient 1 Patient 2
Age (yrs) 62 61 72 71 39 37
Chronic conditions Hypertension diabetes Gout 3 previous MIsa Hypertension CADb COPDc Recurrent sinusitis Recurrent sinusitis
Smoker No No Yes Yes Yes Yes
S. pneumoniae vaccine No No Unknown Unknown No No
Recent antibiotics None None Unknown Unknown >3 courses in previous year >3 courses in previous year
Others in home None None None None None None
Initial complaints URTId symptoms, cough, fever URTId symptom, cough, fevers URTId symptoms, cough, fever chest pain URTId symptoms, cough, fever chest pain, eye discharge Burn, recent URTId symptoms,cough fever Burn, recent URTId,symptoms,cough fever
Physical exam Febrile,↑ HRe, ↑RRf, severe distress, ↓breath sounds Febrile, ↑HRe, ↑RRf, ↓breath sounds Febrile, ↑HRe, RRf,↓breath sounds, ↓O2 saturation Febrile, ↑HRe,↑RRf, ↓breath sounds Febrile, ↑dis- tress on venti- lator, ↓breath sounds, crepitations Febrile, ↑dis- tress on venti- lator, ↓breath sounds, crepitations
Chest X-ray (admission or as noted) Right upper lobe consolidation Right lower lobe consolidation Bibasilar consolidation Extensive right-sided consolidation Day 3 –extensive bilateral consolidation Day 2 – extensive bilateral consolidation
Admitting diagnosis Right lobe pneumonia Bilateral pneumonia Pneumonia Lobar pneumonia Burn Burn
Discharge diagnosis Right upper lobe pneumonia Right lower lobe pneumonia Pneumonia Lobar pneumonia Burn complicated by pneumonia Burn complicated by pneumonia fatal sepsis
Complications Empyema, osteomyelitis None None None None Died
Source of isolate Day 1–blood Day 1–blood Day 1–sputum (4+i) Day 1–sputum (3+i) Day 3–ETTg (4+i) Day 2–BALh (105 CFU/mLi)
Gram stain Not applicable Not applicable GPC resembling S. pneumoniaej GPC resem- bling S. pneu- moniaej, GNBk GPC resembling S. pneumoniaej GPC resembling S. pneumoniaej
Other potential pathogens when pneumonia diagnosed None None None H. influenzae (3+i) GNBk H. influenzae (103 CFU/mLi)
Antibiotic susceptibilityl
Penicillin 2 R 1.5 I 1.5 R 2 I 1.5 I 1 I
Cefuroxime 4 R 6 R 3 R 4 R 6 R 4 R
Ceftriaxone 1 I 0.5 S 0.75 S 0.38 S 0.75 S 0.75 S
TMP/SMXm >32 R >32 R >32 R >32 R >32 R >32 R
Erythromycin 0.25 S 0.25 S 16 R 16 R 0.25 S 0.25 S
Serotype 14 14 9V 9V 9V 9V
PFGE patternn AA AA BB BB BC BC

aMyocardial infarction.
bCoronary artery disease.
cChronic obstructive pulmonary disease.
dUpper respiratory tract infection.
eHeart rate.
fRespiratory rate.
gEndotracheal tube.
hBronchoalveolar lavage.
iFor sputum or ETT aspirates, 3+ & 4+ reflect growth on the third and fourth set of streaks, respectively, on the culture plate; for BAL, sample fluid is an approximately 100-fold dilution of lung fluid.
jGram-positive lancet-shaped cocci found singly, in pairs or in short chains.
kGram-negative coccobacilli.
lAntibiotic susceptibilities reported as MIC (micrograms/mL) and as S (susceptible), I (intermediate) or R (resistant) (NCCLS criteria).
mTMP/SMX (trimethoprim/sulfamethoxazole).
nPulsed-field gel electrophoresis.

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